Proton
pump inhibitors (PPIs) are used widely in the management of acid-related
disorders and, for the majority of patients, oral therapy is effective.
PPI drugs have enabled improved treatment of various
acid-peptic disorders, including gastroesophageal reflux disease, peptic
ulcer disease, and
nonsteroidal anti-inflammatory drug­induced gastropathy.
See this informative page
gerd diet.

Types of Proton Pump Inhibitors

Omeprazole, lansoprazole, rabeprazole, and
esomeprazole appear to have similar efficacy.
Omeprazole (Prilosec)
Email -
I have been taking omeprazole for a number of years due to having a
hiatal hernia, causing as you well know GERD. In recent months I have
been experiencing slight dizziness from time to time. Further, I also
recently noticed, that my prescription container has posted a warning as
to dizziness. Would you please advise to this possibility as it may
solve the reason for my getting dizziness all of a sudden. My primary
care physician has led me to believe the problem stems from my ears and
ordered a motion sickness drug, that made me feel worse. I discontinued
the use of this drug and felt better. However, the dizziness still
persists from time to time. This drug has also caused other problems for
me, such as vitamin D and calcium deficiency that has ultimately caused
severe bone density problems. Is there any solution in resolving all
these problems that this drug is doing to me and what can I do to
improve these conditions, caused by said drug omeprazole.
Lansoprazole (Prevacid)

Combining with
natural supplements
Clin Exp Gastroenterol. 2013. Outcomes in patients with nonerosive reflux
disease treated with a proton pump inhibitor and alginic acid ± glycyrrhetinic
acid and anthocyanosides. The purpose of this study was to compare the efficacy
of alginic acid alone versus alginic acid combined with low doses of pure
glycyrrhetinic acid and bilberry anthocyanosides as an addon to conventional
proton pump inhibitor therapy in relieving symptoms associated with nonerosive
reflux disease. Use of low doses of pure glycyrrhetinic acid + bilberry
anthocyanosides, together with alginic acid as addon therapy, substantially
improves symptoms in patients with nonerosive reflux disease without increasing
side effects or worsening tolerability or compliance.

Long Term Proton
Pump Inhibitor use and consequencesOmeprazole began to be used in 1988. They were considered safe but there
are some concerns about the possibility of an association with cancer,
infection, and gastric atrophy; current concerns about long-term
therapy are centered mainly on a possible association
with fundic gland polyps and between Helicobacter pylori and gastric
atrophic changes. Long-term usage is
difficult to define and most patients take proton-pump inhibitors
non-continuously. Data indicate that a substantial proportion of long-term
users do not have a clear indication for their therapy and there is thus
room for reduction or rationalization of treatment. Overall, on-demand
therapy is more cost-effective than continuous therapy and should be
considered wherever possible.

Chronic use may lead to confusion, delirium, and
dementia.

Ann Pharmacother. 2013. Proton pump
inhibitor-associated hypomagnesemia: what do FDA data tell us? All PPIs
were associated with low magnesium blood levels, with esomeprazole
having the lowest risk and pantoprazole having the highest risk.

Proton Pump Inhibitors
and Risk of Cancer
Does the use of these medications that reduce stomach
acid, or the use of H2 blockers increase the risk of cancer of the
esophagus or stomach? Common H2 blockers are ranitidine (Zantac) and cimetidine (Tagamet); and a common proton pump inhibitor is omeprazole (Prilosec).
Dr. Mats Lindblad and colleagues at the Karolinska Institute in Stockholm
evaluated 7 years of patient data entered into the UK general practice
database. The team identified 287 patients with esophageal cancer and 522
with stomach cancer. These subjects were compared with 10,000 randomly
selected subjects without cancer. The authors found some conditions for
which acid-suppressing drugs are used, such as acid reflux disease, hiatal
hernia and Barrett's esophagus, were associated with an increased risk of
stomach and esophagus cancer. However, no apparent cancer risk was seen
with other conditions, including peptic ulcer, gastritis, and indigestion.
They found no evidence that the proton pump inhibitor drugs themselves
increased the risk. However, Dr. Kenneth E.L. McColl, of the Western
Infirmary, Glasgow, UK says "a major weakness in the study is the
relatively short duration of acid suppressive therapy examined. The
development of cancer in humans is a slow process. The period in question
is really too short to identify or exclude any direct effect between acid
suppressive medication and stomach or esophageal cancers." Gut, November
2006.
Dr. Sahelian says: I agree with Dr. McColl. It would take at least
a 10 to 20 year longitudinal study to determine whether proton pump
inhibitor drugs reduce or increase the risk for cancer and other health
conditions.

JAMA. Dec 11 2013.
Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12
deficiency. Previous and current gastric acid inhibitor use was significantly
associated with the presence of vitamin B12 deficiency. These findings should be
considered when balancing the risks and benefits of using these medications.

I saw a page on
your website about these drugs and see from yours and others that they can
inhibit absorption of calcium. I am wondering if there has been research on
absorbtion of B12? I have taken Prilosec and the over the counter form for
several years on a daily basis per my GI doctor. But since then have been
deficient on B12. Just wondering if there is anything available on this.
Long-term use of PPIs may lead to vitamin B12 deficiency, more
likely in the elderly, or in persons with Zollinger-Ellison Syndrome who are on
high doses of PPI for prolonged periods of time. World J Gastroenterol. 2010. Safety of the long-term use of proton pump inhibitors.

Institutionalized older individuals on PPI for more than 12 months may be more
likely to be vitamin B(12) deficient than non-PPI users. Additionally, treatment
of PPI users with cyanocobalamin nasal spray for 8 weeks could improve vitamin
B(12) status. J Nutr Elder. 2010. Vitamin B(12) deficiency is linked with
long-term use of proton pump inhibitors in institutionalized older adults: could
a cyanocobalamin nasal spray be beneficial? Department of Health, Nutrition, and Exercise Science, University of
Delaware, Newark, Delaware 19716, USA.

Heartburn Medication May not
be Safe
-- Side effects of proton pump inhibitor drugsProton-pump inhibitors that
block stomach acid production increase the risk of an increasingly common
infectious form of diarrhea. Taking a heartburn medication such as AstraZeneca's Nexium
or Losec or their generic versions significantly increases the risk of
diarrhea blamed on the Clostridium difficile bacteria. Frequently
prescribed anti-heartburn drugs called H2 antagonists that include
GlaxoSmithKline's Zantac double the risk of the bacterial
diarrhea. PPIs and H2 antagonists reduce gastric acid, allowing for bacteria to multiply
in the digestive system. Clostridium is the third-most common type of
infectious diarrhea in patients aged 75 and older. Exposure to Clostridium difficile
bacteria, which causes infection and inflammation of the intestine,
previously occurred mostly during hospital stays, but cases have
increasingly been contracted in community settings. While antibiotics
formerly blamed for outbreaks of the illness have declined in use, the
acid-blocking drugs have become steadily more popular to treat ulcers and
conditions such as gastric reflux disease.

Even in those without previous heartburn
symptoms, proton pump inhibitors can give rise to such symptoms after
the drugs are stopped. "It thus seems that the drugs induce the symptoms
they are used to treat, which might lead to dependency on such drugs,"
says co-author Dr. Christina Reimer, from Køge University Hospital,
Denmark. Such dependency might explain why use of the medications is
increasing. Gastroenterology, July 2009.

The US Food and Drug Administration recommends
that the coadministration of omeprazole and Plavix (clopidogrel) be
avoided, based on data showing that the proton pump inhibitor reduces
the efficacy of Plavix by nearly 50%. Other drugs which inhibit the
CYP2C19 drug-metabolising enzyme should also be avoided in combination
with clopidogrel.

Common heartburn drugs can cause serious side
effects and should be used with caution. Well-known brands of the drugs
- called proton pump inhibitors or PPIs - include AstraZeneca's Nexium
and Prilosec. Formerly AstraZeneca's biggest seller, Prilosec is
available generically as omeprazole and is also sold over the counter by
Procter & Gamble Co. While the drugs are a great help to the right
patients, they can raise the risk of fractures in post-menopausal women
and cause bacterial infections in many patients. Archives of Internal
Medicine, 2010.

Popular heartburn drugs, including proton pump
inhibitors and histamine-2 receptor antagonists, may raise the risk of
pneumonia, according to Dr. Sang Min Park of the department of family
medicine at Seoul National University Hospital in Korea.

Postmenopausal women
with a history of smoking who take these heartburn drugs for two years
or longer may be more likely to sustain a hip fracture.

Email - I have been
diagnoses with acid reflux, hiatal hernia and diviticulitis. My dx was 2
years ago and I was hospitalized 4 times. I have been on protonpump
inhibitors for this whole period switching a few times from protonix,
tonexium and landsoprozole. Recently, i have been experiencing achy
muscles, feet, calves and my arms and throbbing hands. Each day a
different joint hurt even my hip. I now woke up one day with what was a
sore arm for a few weeks to not being able to move it and was in
excruciating pain.

Withdrawal symptoms
Dr. Anna Niklasson, from Sahlgrenska University Hospital, Goteborg
reports that healthy volunteers who took pantoprazole for 4 weeks had
dyspeptic symptoms when they stopped, probably from rebound secretion of
gastric acid. Dr. Anna Niklasson says, "A 4-week course of pantoprazole
seems to induce dyspeptic symptoms in previously asymptomatic healthy H.
pylori-negative subjects. The correlation between symptom score and
gastrin levels suggests that these symptoms are due to acid rebound
hypersecretion and seem to be related to the degree of acid inhibition.
Am J Gastroenterology, March 2010.

GERD disease and proton
pump inhibitors - acid reflux
Drugs such as Nexium and Prilosec, referred to as proton pump inhibitors,
are effective treatments for gastroesophageal reflux. But when these drugs
fail to bring relief, persistent heartburn may be the result of an
increase in non-acidic reflux. Gastroesophageal reflux disease, or ( GERD
), occurs when fluid in the stomach, which is highly acidic, moves into
the esophagus, typically causing heartburn. Because of the change in body
position, reflux is often worse during sleep. Persistent reflux can cause
permanent changes in the lining of the esophagus, which can lead to
cancer. Dr. Suanne Goodrich and her associates at the Lynn Health Science
Institute in Oklahoma City point out that the role of non-acid reflux
during sleep has not been evaluated. They theorized that non-acidic reflux
during sleep could cause prolonged esophageal exposure to bile salts and
pancreatic enzymes, and increase the risk of inhalation of the reflux
fluid. Fifteen subjects with heartburn were randomly assigned to treatment
with the proton pump inhibitor Nexium (esomeprazole) or to inactive
"placebo" for 1 week. After the week of treatment, the subjects spent a
night in the researchers' lab, where they underwent various reflux tests.
Prior to going to bed, the subjects ate pizza, brownies and grape juice to
increase the likelihood of reflux. Treatment with proton pump inhibitor
Nexium reduced the rate of reflux episodes by approximately half, but the
number of non-acid reflux events rose from 6 to 27. Reflux may cause
arousal during sleep, which actually protects the esophagus by increasing
salivation and swallowing. Most reflux events, either acidic or
non-acidic, result in an arousal response within 2 minutes. The fact that
the esophagus is equally responsive to acidic and nonacid reflux indicates
no increased risk of damage to the esophagus. Chest, 2007.

Intravenous Proton
Pump Inhibitor Drugs

Intravenous administration is a faster way to achieve gastric acid suppression than
oral administration of the same agent. Peak suppression after IV
administration occurs within hours, compared with several days later after
oral administration. Thus the IV route of administration offers a faster
onset of gastric suppression, achievement of intragastric pH closer to
neutrality, and better bioavailability. The proton
pump inhibitors that have IV
formulations in the United States (esomeprazole, lansoprazole, and
pantoprazole) are approved for different indications.

Randomised controlled
trials evaluating the clinical effect of proton pump inhibitors (PPIs) in
peptic ulcer (PU) bleeding have yielded conflicting results. PPI treatment
in PU bleeding reduces rebleeding and surgery compared with placebo or
H(2)RA, but there is no evidence of an overall effect on all-cause
mortality.At equivalent
doses, oral and intravenous (IV) PPIs produce comparable acid suppression;
thus there are very few clinical indications for IV PPI therapy. IV PPIs
are an appropriate substitute for oral PPIs, at an equivalent dose, for
patients with, for example, gastroesophageal reflux disease, peptic
ulceration, or Zollinger-Ellison syndrome, who cannot take oral
medication.

Questions
Q. Are there any herbs that work the same way as PPIs?
A. I am not aware of specific research with herbs that have found
them to work the same way as a proton pump inhibitor. However, certain
herbs have begun to be evaluated in ulcer healing, such as
prickly pear or cactus
pear. Research is still quite early with herbs. See the ulcer link at the
top of the page.

Q. Is it okay to take alpha
lipoic acid or
resveratrol with
a proton pump inhibitor drug?
A. I have not seen studies regarding this combination, but it would
seem that taking 50 mg or less of lipoic acid a few times a week should be
fine.

Q. Q. I take a Proton Pump Inhibitor
prescription medication every day for gastro esophageal reflux disease.
Are there any natural sex booster supplements that you would recommend
someone taking a proton pump inhibitor should avoid?
A. We have not seen any studies that have looked into the
combination of proton pump inhibitors and natural aphrodisiac herbs or
supplements. As a general rule, small amounts or dosages, such as half a
capsule, of the sex herbs should be safe in most people, but have approval
from your doctor.

Q. I am going off of Prilosec and Prevacid. I have
taken them off and on (not at the same time, of course,) over several
years now. I have terrible diarrhea. I cannot leave the house for an hour
after eating. So I stopped taking Prilosec about a week ago. I feel
better, but wonder if I should have just quit taking it abruptly. Any
danger that you know of in that?
A. We are not aware of any withdrawal symptoms from stopping
Prilosec or Prevacid proton pump inhibitors but much depends on the
condition of a person's stomach and intestines and overall health
condition. The decision to stop these proton pump inhibitors depends on a
number of factors that you and your doctor would need to discuss.

Big fan of your vitamins and input on
herbal supplements. I have a 13 year old son that was just diagnosed with
gastritis and acid reflux. He has been put on proton pump inhibitor Prilosec 20mg x3 daily and Carafate 10ml x3 daily. Are there any
supplements that could heal and provide relief?
Perhaps his doctor can read this page, the page on gerd diet,
along with the page on ulcer.

At the age of 19 my son was diagnosed with
hairy cell leukemia. It was treated with Kemo new drug klydrobin (might be
spelled wrong). when he was 15 or so he was put on Protonix for acid
reflex. He became constipated at the time he was 19 and was diagnosed with
leukemia after all was tested through bone marrow biopsy. Today he has to
have another biopsy done WBC is under 2000. But my reason for this email
is to find out if acid drugs might have connection between constipation
and his disease. I had just found out that he is now taking Prilosec.
Bottom line 2 acid drugs second time for low blood count. I am not sure
were to go with this i am looking for any answers. no help from
local doctor.

Proton pump inhibitors (PPIs) are a group of
medications that decreases the amount of acid in the stomach and
intestines. Doctors prescribe PPIs to treat people with GERD, ulcers in
the stomach or intestine, or other digestive disorders that may cause
excess stomach acid. Does the administration of a PPI have any
pronounced effect on the pH of the duodenum?
Since the stomach makes acid, and PPIs reduce the acid
formation, the mixture of food and reduced acid reaches the duodenum and
thus the administration of a PPI will most likely result in a lower
duodenal pH. I am not an expert in this topic but this is my best
understanding.

Do you have any suggestions for treatment of a
hiatal hernia other than a proton pump inhibitor? Those meds are toxic
and horrible to my system.
I have not studied this topic in enough detail yet as far as
natural treatment, but the page on gerd diet may be helpful.